TY - JOUR
T1 - Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery
AU - Kittelson, A.J.
AU - Elings, J.
AU - Colborn, K.
AU - Hoogeboom, T.J.
AU - Christensen, J.C.
AU - van Meeteren, N.L.U.
AU - van Buuren, S.
AU - Stevens-Lapsley, J.E.
N1 - Funding Information:
This study is funded by the Agency for Healthcare Research and Quality (AHRQ R03 HS024316, AHRQ R01 HS025692) and the National Institutes of Health (NIH K12 HD055931). The funding body had no role in the study design, data collection, data analysis, and interpretation of data, nor any role in writing the manuscript.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/7/22
Y1 - 2020/7/22
N2 - Background Clinicians and patients lack an evidence-based framework by which to judge individual-level recovery following total knee arthroplasty (TKA) surgery, thus impeding personalized treatment approaches for this elective surgery. Our study aimed to develop and validate a reference chart for monitoring recovery of knee flexion following TKA surgery. Methods Retrospective analysis of data collected in routine rehabilitation practice for patients following TKA surgery. Reference charts were constructed using Generalized Additive Models for Location Scale and Shape. Various models were compared using the Schwarz Bayesian Criterion, Mean Squared Error in 5-fold cross validation, and centile coverage (i.e. the percent of observed data represented below specified centiles). The performance of the reference chart was then validated against a test set of patients with later surgical dates, by examining the centile coverage and average bias (i.e. difference between observed and predicted values) in the test dataset. Results A total of 1173 observations from 327 patients were used to develop a reference chart for knee flexion over the first 120 days following TKA. The best fitting model utilized a non-linear time trend, with smoothing splines for median and variance parameters. Additionally, optimization of the number of knots in smoothing splines and power transformation of time improved model fit. The reference chart performed adequately in a test set of 171 patients (377 observations), with accurate centile coverage and minimal average bias (< 3 degrees). Conclusion A reference chart developed with clinically collected data offers a new approach to monitoring knee flexion following TKA.
AB - Background Clinicians and patients lack an evidence-based framework by which to judge individual-level recovery following total knee arthroplasty (TKA) surgery, thus impeding personalized treatment approaches for this elective surgery. Our study aimed to develop and validate a reference chart for monitoring recovery of knee flexion following TKA surgery. Methods Retrospective analysis of data collected in routine rehabilitation practice for patients following TKA surgery. Reference charts were constructed using Generalized Additive Models for Location Scale and Shape. Various models were compared using the Schwarz Bayesian Criterion, Mean Squared Error in 5-fold cross validation, and centile coverage (i.e. the percent of observed data represented below specified centiles). The performance of the reference chart was then validated against a test set of patients with later surgical dates, by examining the centile coverage and average bias (i.e. difference between observed and predicted values) in the test dataset. Results A total of 1173 observations from 327 patients were used to develop a reference chart for knee flexion over the first 120 days following TKA. The best fitting model utilized a non-linear time trend, with smoothing splines for median and variance parameters. Additionally, optimization of the number of knots in smoothing splines and power transformation of time improved model fit. The reference chart performed adequately in a test set of 171 patients (377 observations), with accurate centile coverage and minimal average bias (< 3 degrees). Conclusion A reference chart developed with clinically collected data offers a new approach to monitoring knee flexion following TKA.
KW - clinical decision making
KW - functional-activities
KW - generalized additive models for location scale and shape
KW - hip
KW - monitoring
KW - motion
KW - outcomes
KW - performance
KW - PERFORMANCE
KW - FUNCTIONAL-ACTIVITIES
KW - HIP
KW - Clinical decision making
KW - MOTION
KW - Generalized additive models for location scale and shape
KW - OUTCOMES
KW - Monitoring
UR - https://springernature.figshare.com/articles/dataset/Additional_file_1_of_Reference_chart_for_knee_flexion_following_total_knee_arthroplasty_a_novel_tool_for_monitoring_postoperative_recovery/12696012/1
U2 - 10.1186/s12891-020-03493-x
DO - 10.1186/s12891-020-03493-x
M3 - Article
C2 - 32698900
SN - 1471-2474
VL - 21
JO - BMC Musculoskeletal Disorders
JF - BMC Musculoskeletal Disorders
IS - 1
M1 - 482
ER -